This application is based upon and claims the benefit of priority from the prior Japanese Patent Applications No. 2000-244402, filed Oct. 16, 2000; and No. 2001-244402, filed Aug. 10, 2001, the entire contents of both of which are incorporated herein by reference.
1. Field of the Invention
The present invention relates to a physiological tissue clipping apparatus, clipping method and clip unit mounting method for inserting an endoscope into a cavity endoscopically, for example, and clipping a physiological tissue.
2. Description of the Related Art
As a physiological tissue clipping apparatus, there is known a mechanism disclosed in Japanese Patent Application KOKAI Publication No. 8-19548, for example. This clipping apparatus is composed of a clip unit 10 and a clip manipulating device 106, as shown in FIG. 28A and FIG. 28B. The clip unit 101 causes a link member 103 to be engaged with a clip 102, and further, engages a clip tightening ring 104. A link member 103 is composed of a plate material, and an engagement hole 103b is provided to be linked with a hook section 112 of the clip manipulating device 106.
The clip manipulating device 106 composed of an insert section 106a and a frontal manipulating section 106b. The insert section 106a is composed of an introducing tube 107, a manipulating tube 109 routed into the introducing tube 107, and a manipulating wire 110 routed into the manipulating tube 109. The hook section 112 having a pin 111 to be linked with a link member 103 is provided at the manipulating wire 110. The frontal manipulating section 106b is composed of: a tube joint 114 fixed frontally of the introducing tube 107; a manipulating section main body 115 for manipulating the manipulating tube 109 to be advanced or retracted; and a slider section 116 for manipulating the manipulating wire 110 to be advanced or retracted.
Therefore, the clip unit 101 is mounted on the clip manipulating device 106, and is introduced into a cavity in accordance with the following procedures.
(1) The manipulating section main body 115 is pushed against a tip end side, and the manipulating tube 109 is protruded from the introducing tube 107.
(2) The slider section 116 is pushed against a tip end side, and the hook section 103a is protruded from the manipulating tube 109.
(3) The pin 111 is engaged through the engagement hole 103b while the engagement hole 103b of the link member 103 of the clip unit 101 is aligned with the pin 111 of the hook section 112 of the clip manipulating device 106.
(4) The slider section 116 is pulled toward a proximal end side, and the tightening ring 104 of the clip unit 101 is engaged with a tip end of the manipulating tube 109.
(5) The manipulating section main body 115 is pulled to the proximal end side, and the clip unit 101 is stored in the introducing tube 107.
(6) The clip unit is introduced into a cavity via an endoscope.
Next, the clip unit 101 is ligated in accordance with the following procedures.
(1) The manipulating section main body 115 is pushed to the tip end side, and the clip unit 101 is protruded from the inside of the introducing tube 107.
(2) The slider section 116 is slightly pulled toward the proximal end side, and the clip 102 is placed in an expanded state.
(3) The slider section 116 is pulled toward the proximal end side, the tightening ring 104 is engaged with the clip 102, and the clip 102 is ligated.
In addition, as a configuration of the introducing tube and the manipulating wire, for example, an endoscope treatment tool disclosed in Japanese Patent Application KOKAI Publication No. 2-239855 is known. Structurally, this endoscope treatment tool comprises: an external sheath tube; a manipulating wire retractably inserted into this external sheath tube to be advanced and retracted by manipulation from the frontal side; a treatment section mounted on this manipulating wire, the treatment section being capable of manipulating the treatment tool at the tip end side of the external sheath tube by advancement and retraction of such manipulating wire and being configured by an elastic wire; an extension section wire expanding at least one end of this elastic wire, the extension section wire being introduced into the external sheath tube; and a plurality of bent sections forming either of this extension section wire and the above manipulating wire to be bent in the external sheath tube and securely mounting it to another one.
Therefore, when this endoscope treatment tool advances and retracts a manipulating wire by manipulating a manipulating section, and actuates a treatment section, slackness is reduced in the external sheath tube of the manipulating wire or extension section wire. Therefore, a loss of a manipulating quantity of the manipulating section is very small, and the treatment section at the tip end of the external sheath tube can be reliably manipulated.
In addition, as a configuration of the introducing tube and the manipulating wire, an endoscope injector disclosed in Japanese Utility Model Application KOKAI Publication No. 5-91686 is known. This endoscope injector is such that a manipulating section and a puncture section are linked with each other via a double tube composed of an internal sheath tube and an external sheath tube. A protrusion quantity restricting member for stabilizing a projection quantity of an injection needle provided at a tip end of the internal sheath tube is provided at a tip end of the external sheath tube, and a side face of a stopper and a side face of a protrusion quantity restricting member are slid each other, whereby the movement quantity of the injector needle is restricted.
Further, a configuration of the manipulating section, an endoscope injector disclosed in Japanese Utility Model Application KOKAI Publication No. 62-78901 is known. This injector comprises: an injection tube having flexibility; a tubular tip end needle mounted on a tip end of this injection tube; a flexible external sheath tube having the tip end needle and the injection tube slidably routed; an injection pipe connected to a proximal end of the injection tube at the frontal inside of this external sheath tube; and a fixing mechanism for, when the tip end needle provided at the tip end part of the external sheath tube protrudes from the tip end of the external sheath tube, and is restricted in abutment against the stopper, compressing this injection tube to be fixed to the external sheath tube.
However, in the clipping apparatus disclosed in Japanese Patent Application KOKAI Publication No. 8-19548, a tube joint 114 for advancing and retracting an introducing tube 107, a manipulating section main body 115 for advancing and retracting a manipulating tube 109, and a slider section 116 for advancing and retracting the manipulating wire 110 are provided at frontally of a manipulating section 106b. 
Therefore, over six steps between (1) and (2), it is required to manipulate the tube joint 114, manipulating section main body 115, and manipulating wire 110 to be advanced and retracted, which complicates manipulation.
In addition, the following steps are required to mount the clip unit 101 on the hook section 112:
(1) the link member 103 of the clip unit 101 is held in a horizontal direction relevant to a cutout provided at the hook section 112;
(2) the pin 111 provided at the hook section 112 is engaged with the engagement hole 113b provided at the link section 113 while they are aligned with each other so that the pin 111 is engaged with the engagement hole 103b. Thus, two steps of (1) orientation and (2) alignment must be carried out at the same time, making it difficult to carry out a mounting work.
In order to ligate the clip unit 101, the clip 102 is held to the maximally opened state, making it necessary to ligate a target site in this state. However, if manipulation is incorrect, the maximally opened state is passed, making it impossible to ligate the target site. Thus, the slider section 116 must be carefully manipulated, which makes manipulation difficult.
In the Japanese patent Application KOKAI Publication No. 2-239855, the slackness of a wire when the manipulating wire can be eliminated in consideration of application of the clip manipulating device to the manipulating wire.
However, when the introducing tube is bent, the manipulating wire slips out of an axial center of the introducing tube. Therefore, when the clip unit is mounted on the hook section, the position of the hook section is changed according to the shape of the introducing tube, and can be safely fixed, thus making it difficult to mount the clip unit on the hook section.
In addition, in Japanese Patent Utility Model Application KOKAI Publication No. 5-91686, the hook section can be positioned at the axial center of the introducing tube in consideration of application of the clip manipulating device to the hook section and introducing tube. However, a structure is mandatory such that a tip end part of the introducing tube is contracted in a tapered shape. When the contraction section is defined as an internal diameter through which the clip unit can pass, an external diameter of the introducing tube is increased. In addition, in order to enable the hook section to be reliably engaged with the link member of the clip unit, the length of the hook section must be fully protruded from the tip end of the introducing tube. Because of this, the length of the hook section is increased, the flexibility of the introducing tube is lost when the hook section is pulled into the introducing tube, making it difficult to ensure routing into a soft endoscope or protrusion of the hook section.
Further, in consideration of the fact that a fixing mechanism of a manipulating section disclosed in Japanese Utility Model Application KOKAI Publication No. 62-78901 is applied to a fixing mechanism of a slider of a clip manipulating device, in a fixing mechanism caused by an elastic rubber ring, an amount of the actuation force when the slider is fixed is equal to that when the slider is released. In order to facilitate fixing, when an elastic rubber ring with a small amount of force is employed, the release can be ensured with a small amount of force similarly, making it impossible to ensure reliably fixing. Conversely, when an elastic rubber ring with a large amount of force is employed in order to make the release difficult, the fixing becomes heavy, makes it difficult to make manipulation.
The present invention has been made in order to solve the foregoing problem. It is an object of the present invention to provide a physiological tissue clipping apparatus capable of inserting a clip into a physiological cavity while the clip is housed in an introducing tube, and further engaging the housed clip at the same time when the clip is released from the introducing tube merely by manipulating a manipulating member to be advanced and retracted, capable of ligating the clip, and capable of being easily handled.
According to one aspect of the present invention, there is provided a clipping apparatus comprising:
a clip capable of being arbitrarily opened/closed;
a tightening ring engagingly mounted on this clip, thereby closing the clip;
a link member capable of being inserted into this tightening ring and engaged with the clip;
an introducing tube capable of housing the clip and the tightening ring;
a manipulating member retractably routed into this introducing tube; and
engagement means provided at at least one of the tightening ring and the introducing tube, the engagement means engaging the introducing tube with the tightening ring when the clip and tightening ring protrudes in front of the introducing tube, and disabling the tightening ring from being housed again in the introducing tube.
According to another aspect of the present invention, there is provided a clipping apparatus comprising:
a clip capable of being arbitrarily opened/closed;
a tightening ring engagingly mounted on this clip, thereby closing the clip;
a link member capable of being inserted into this tightening ring and engaged with the clip;
an introducing tube capable of housing the clip and the tightening ring;
a manipulating member retractably routed into this introducing tube; and
a cover provided on the clip capable of entering an opened state required to ligate a physiological tissue from a closed state capable of being inserted into an endoscope.
According to another aspect of the present invention, there is provided a clipping apparatus comprising:
a clip capable of being arbitrarily opened/closed;
a tightening ring engagingly mounted on this clip, thereby closing the clip;
a link member capable of being inserted into this tightening ring and engaged with the clip; and
a manipulating wire having a hook at its tip end, wherein, when the link member is set at an arbitrary peripheral position relevant to an axial direction of the hook, at least one of the link member and the hook is deformed and restored, whereby the link member and the hook are engaged with each other.
According to another aspect of the present invention, there is provided a clipping apparatus comprising:
a clip capable of being arbitrarily opened/closed;
a tightening ring engagingly mounted on this clip, thereby closing the clip;
a link member capable of being inserted into this tightening ring and engaged with the clip; and
holding means for, when the clip is opened to the maximum, temporarily holding the opened state.
According to another aspect of the present invention, there is provided a clipping apparatus comprising:
a clip capable of being arbitrarily opened/closed, the clip being made of an ultra-elastic alloy;
a tightening ring engagingly mounted on this clip, thereby closing the clip; and
a link member capable of being inserted into this tightening ring and engaged with the clip.
According to the physiological tissue clipping apparatus, the link member is engaged with the clip, and further, the tightening ring is mounted on the manipulating wire as a manipulating member. Then, the manipulating member is manipulated, all of the clip, link member, and tightening ring are housed in the introducing tube to be introduced into a cavity. After this introduction, the manipulating member is manipulated, the clip, link member, and tightening ring are protruded to the outside of the introducing tube, and the introducing tube and the tightening ring are engaged with each other. Then, the manipulating member is manipulated again, the tightening ring is engaged with the tightening ring, and the clip is ligated. Therefore, merely by manipulating the manipulating member to be advanced and retracted, the housed clip can be engaged at the same time when the clip is released from the introducing tube, and the clip can be ligated.
According to another aspect of the present invention, there is provided a physiological tissue clipping method comprising:
a first step of connecting a clip unit housed in a clip case on a clip manipulating device;
a second step of routing the clip manipulating device into a soft endoscope, thereby guiding the clip unit into a target site of a physiological tissue; and
a third step of manipulating the clip manipulating unit, thereby clipping the clip unit at the physiological tissue.
According to the present invention, there is provided a physiological clipping method comprising:
a first step of connecting a clip unit housed in a clip case with a clip manipulating device, and manipulating the clip manipulating device, thereby mounting the clip unit on the clip manipulating device;
a second step of routing the clip manipulating device into a soft endoscope, thereby guiding the clip unit into a target site of a physiological tissue; and
a third step of manipulating the clip manipulating unit, thereby clipping the clip unit at the physiological tissue.
According to the physiological tissue clipping method, a series of operations can be easily made such that the clip unit in the clip case is mounted on the clip manipulating device, this clip manipulating device is pulled toward the target site of the physiological tissue, and the clip unit is clipped at the physiological tissue.
According to another aspect of the present invention, there is provided a clip unit mounting method comprising:
a first step of connecting a clip manipulating member in a clip case to a clip unit; and
a second step of mounting the clip unit housed in the clip case on a clip manipulating device.
According to another aspect of the present invention, there is provided a clip unit mounting method comprising:
a first step of connecting a clip unit housed in a clip case with a sheath of a clip manipulating device having a clip manipulating member retractably inserted thereinto;
a second step of advancing the clip manipulating member, thereby connecting the clip unit with the clip manipulating member in the clip case; and
a third step of retracting the clip manipulating member, thereby guiding the clip unit housed in the clip case to the inside of the sheath, and mounting the guided clip unit thereon.
According to the clip unit mounting method, a series of operations can be easily made such that the clip unit housed in the clip case is pulled in by the clip manipulating device, and the guided clip unit is mounted on the clip manipulating device.
Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.